Health care reform dogged by uncertainty

Business executives don’t like uncertainty, but it’s a condition retail pharmacy operators and others involved in health care delivery will have to learn to live with for the foreseeable future.

In addition to the tenuous economic recovery, recent developments that call into question the progress of health care reform will greatly complicate the task of preparing a company to meet the needs of patients and remain financially viable in 2014, when the major provisions of the Patient Protection and Affordable Care Act are scheduled to go into effect.

The Republican-controlled House of Representatives voted last month to repeal the landmark legislation signed into law by President Obama in March 2010. Some may dismiss the measure as political theater, since there is almost no chance that it will pass in the Senate, where Democrats retain a majority, and, in any event, would face a certain presidential veto.

Passage of the bill in the House does, however, reflect the deep split among legislators and their constituents over health care reform, as well as the critics’ determination to make implementation as difficult as possible. Count on many Republicans to try to limit funding for the program and tie up officials responsible for reform in a series of committee hearings.

Their goal will be to keep the issue alive at least until 2012, when Obama will be up for re-election.

Another, perhaps more serious, threat to health care reform came later in the month when Roger Vinson, a federal district court judge in Pensacola, Fla., ruled the legislation unconstitutional. He found that Congress exceeded its authority by requiring individuals to buy health insurance or face tax penalties, thus scuttling the entire act.

Vinson’s decision echoed that of another federal district court judge, who struck down the health insurance requirement but allowed other portions of the measure to stand. The law previously passed muster with two of the judges’ colleagues in other jurisdictions. The conflicting legal views will ultimately be sorted out by the Supreme Court, although the appellate proceedings could take two years or more.

The ongoing battles in the legislative and judicial arenas — not to mention a rule-making process that will generate its share of controversy — mean that, in the near term, there are likely to be as many questions about the direction of the U.S. health care system as there are answers. That’s sure to make a lot of people in community pharmacy very nervous.